Vancomycin Hypersensitivity Reactions Documented in Electronic Health Records

Santiago Alvarez-Arango, Sharmitha Yerneni, Olive Tang, Li Zhou, Christian M. Mancini, Suzanne V. Blackley, Corinne Allison Keet, Kimberly G. Blumenthal

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Vancomycin, the most common antimicrobial used in US hospitals, can cause diverse adverse reactions, including hypersensitivity reactions (HSRs). Yet, little is known about vancomycin reactions documented in electronic health records. Objective: To describe vancomycin HSR epidemiology from electronic health record allergy data. Methods: This was a cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems. We determined prevalence and trends of vancomycin DALs and assessed active DALs by HSR phenotype determined from structured (coded) and unstructured (free-text) data using natural language processing. We investigated demographic associations with documentation of vancomycin red man syndrome (RMS). Results: Among 4,490,618 patients, 14,426 (0.3%) had a vancomycin DAL with 18,761 documented reactions (2,248 [12.0%] free-text). Quarterly mean vancomycin DALs added were 253 ± 12 and deleted were 12 ± 2. Of 18,761 vancomycin HSRs, 7,903 (42.1%) were immediate phenotypes and 3,881 (20.7%) were delayed phenotypes. Common HSRs were rash (32% of HSRs) and RMS (16% of HSRs). Anaphylaxis was coded in 6% cases of HSRs. Drug reaction eosinophilia and systemic symptoms syndrome was the most common coded vancomycin severe cutaneous adverse reaction. RMS documentation was more likely for males (odds ratio, 1.30; 95% CI, 1.17-1.44) and less likely for blacks (odds ratio, 0.59; 95% CI, 0.47-0.75). Conclusions: Vancomycin causes diverse adverse reactions, including common (eg, RMS) and severe (eg, drug reaction eosinophilia and systemic symptoms syndrome) reactions entered as DAL free-text. Anaphylaxis comprised 6% of documented vancomycin HSRs, although true vancomycin IgE-mediated reactions are exceedingly rare. Improving vancomycin DAL documentation requires more coded entry options, including a coded entry for RMS.

Original languageEnglish (US)
Pages (from-to)906-912
Number of pages7
JournalJournal of Allergy and Clinical Immunology: In Practice
Issue number2
StatePublished - Feb 2021


  • Allergy
  • Drug allergy label
  • Drug reaction eosinophilia and systemic symptoms syndrome
  • Electronic health record
  • Epidemiology
  • Hypersensitivity
  • Infusion reaction
  • Phenotype
  • Red man syndrome
  • Vancomycin

ASJC Scopus subject areas

  • Immunology and Allergy


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